tbuckley/cabot-search huggingface dataset:
Abstract 13967: Association Between Artificial Intelligence Identified Radiographic Pulmonary Vascular Injury and Cardiac Structure and Function in Patients With <i>Chronic Obstructive Pulmonary Disease</i>
Authors: Lisa S Duus, Ditte Andersen, Anne B Nielsen, Pradeesh Sivapalan, Charlotte S Ulrik, Therese Lapperre, Andrea Browatzki, Ruben San Jose Estepar, Pietro Nardelli, Jens-Ulrik Staehr Jensen, Raul San Jose Estepar, Tor Biering-Srensen
Journal: Circulation (2022)

Background Early recognition of cardiac dysfunction in patients with chronic obstructive pulmonary disease (COPD) may prevent future cardiac impairment and improve prognosis. Artificial intelligence (AI) using neural networks on Computed Tomographic (CT) imaging provides a measurement of loss of small vessel volume, as a surrogate of pulmonary vascular injury, and a compensatory increase in large vessel volume. This study investigated pulmonary vascular alteration in patients with COPD and its association with cardiac structure and function assessed by echocardiography. Methods: We studied 205 prospectively enrolled patients with COPD with an available CT scan and echocardiogram. AI algorithms calculated the small - and large vessel fraction as respectively the vascular volume in small vessels (5-10 mm 2 ) and large vessels (20-90 mm 2 ), indexed to total intrapulmonary vessel volume. Univariable and multivariable linear regressions were conducted, and standardized ß-coefficients were calculated. The multivariable model was adjusted by CT reconstruction kernel (spatial resolution). Results: In the unadjusted model, we found that loss in small vessel fraction and increase in large vessel volume were associated with higher left ventricular (LV) mass, LV diastolic dysfunction, and inferior vena cava dilatation. Small vessel fraction was also associated with right ventricular remodeling, while large vessel fraction was associated with higher pulmonary pressure. After adjustment, all measures remained significantly associated, except for tricuspid annular plane systolic excursion which did not. Measures of LV mass and right atrial pressure displayed the greatest associations with pulmonary vascular damage. Conclusion: We found that pulmonary vascular damage assessed by loss in small vessel fraction and increase in large vessel fraction, as assessed by AI on CT imaging, may negatively affect cardiac structure and function in patients with COPD.
Abstract 12769: Association of Lung Protective Ventilation and Outcomes in Patients With Cardiogenic Shock on ECLS
Authors: Lena E Tran, Bryan Auvil, Meng Xu, Shi Huang, Whitney Gannon, Matthew Bacchetta, Ashish S Shah, Keki Balsara, Hasan K Siddiqi, Sandip Zalawadiya, D. M Brinkley, Joann Lindenfeld, Dawn Pedrotty, Jonathan Menachem, Kelly H Schlendorf, Antonio Hernandez, Aniket S Rali
Journal: Circulation (2022)

Background: In Acute Respiratory Distress Syndrome, lung protective ventilation (LPV) improves patient outcomes by minimizing the risk of ventilator-associated lung injury. For patients with cardiogenic shock (CS) requiring VA-ECLS, the extracorporeal heart-lung circuit provides a unique opportunity to provide LPV. At present, there are limited data regarding optimal ventilator strategies for patients in CS on VA-ECLS. We hypothesized that CS patients on VA-ECLS who require ventilator support will have better outcomes with LPV. Methods: We queried Extracorporeal Life Support Organization (ELSO) registry for hospital admissions between 2009 and 2019 for CS patients on VA-ECLS and mechanical ventilation. Patients with multiple ECLS runs, congenital heart disease, pre-ECLS cardiac arrest, and durable mechanical circulatory support were excluded. We defined LPV as peak inspiratory pressure (PIP24)&lt;30 cm H 2 O at 24 hours on ECLS. ELSO registry does not report tidal volume, hence, PIP24 was used as surrogate for plateau pressure. PIP24 and driving pressure (PIP24 minus PEEP24) at 24 hours (DP24) were also studied as continuous variables. Our primary outcome was survival to discharge. Multivariable analysis adjusted for baseline SAVE score, age, race, BMI, etiology of CS, intubation hours prior to ECMO and history of chronic lung disease. Results: A total of 2,226 CS patients on VA-ECLS were included of which 1904 received LPV. LPV patients had a significantly lower BMI (median 28.28 vs 31.14, p&lt;0.001), and were less sick, as assessed by their baseline SAVE score (-1.79 vs -2.79, p=0.002). The primary outcome of survival to discharge was significantly greater in LPV cohort (47.4% vs 32.6%, p&lt;0.001). Median PIP24 (22 vs 24, p&lt;0.001) as well as DP24 (14.5 vs 16, p&lt;0.001) were significantly lower in those surviving to discharge. Adjusted OR for primary outcome with LPV was 1.69 (p=0.0023). Adjusted OR for primary outcome with incremental rise in PIP24 (0.78, p=0.0003) and DP24 (0.75, p&lt;0.0001) were also statistically significant. Conclusions: In VA-ECLS patients requiring mechanical ventilation, LPV and lower PIP and DP at 24 hours is associated with improved survival to discharge.
Abstract 14349: The Association Between Atherosclerotic Cardiovascular Disease Outcomes and Diseases of Despair: A Retrospective Analysis From 2017-2021
Authors: Matthew S Nudy, Kathleen Galper, Daniel R George, Jennifer L Kraschnewski, Lawrence I Sinoway, Emily Brignone
Journal: Circulation (2022)

Introduction: Diseases of despair (DoD) are a major cause of premature mortality in the United States (U.S.) and include substance use and sequela, and suicidality. How despair-related illnesses are associated with atherosclerotic cardiovascular disease (ASCVD) and impact healthcare utilization in those with ASCVD is not established. Methods: International Classification of Diseases-10 codes were used to identify adults in the Highmark Health insurance claims database with ASCVD (composite of myocardial infarction, ischemic stroke, ischemic cardiomyopathy and peripheral vascular disease) from 2017-2021. In patients with ASCVD, baseline characteristics were compared between those with and without DoD. Hazard ratios (HR) and 95% confidence intervals (CIs) were calculated to assess the risk of ASCVD between those with and without DoD over 5-years of follow-up. Results: Among patients analyzed (n=983,513), 67,340 were diagnosed with ASCVD. Among those with ASCVD, 3.1% (2,059) had DoD. Those with DoD that developed ASCVD were younger (&lt;45 years), more likely to smoke, more likely to use psychotherapy services, had more inpatient and outpatient utilization, and had increased total healthcare costs relative to those without DoD that developed ASCVD (Table 1). In addition, those with DoD had an increased risk of ASCVD compared to those without DoD (HR 1.43; 95% CI 1.37-1.50). Covariates adjusted for include frailty, obesity, smoking, gender, age, rurality, and area-level poverty, educational attainment, and social vulnerability. Conclusions: Among adults with ASCVD, those with DoD are younger and have higher healthcare utilization. In addition, DoD is associated with an increased risk of ASCVD. Further research to understand cardiovascular disease prevention in those with DoD could reduce healthcare costs and save lives. Also, there is a need to examine overlapping structural factors that may be contributing to concurrent rises in both ASCVD and DoD in the U.S.
Abstract 143: Does Bystander Gender Make Difference In Outcomes Of Out Of Hospital Cardiac Arrest?
Authors: Gyeongmin Lee, Hanna Yoon, Kyoung J Song, Kijeong Hong, Ki Hong Kim, YongJoo Park, Stephen Gyung Won LEE, Seul Ki Choi, Wonpyo Hong, Hyouk Jae Lim, Kang bin Lee
Journal: Circulation (2022)

Objective: We hypothesize that there is difference in outcomes of out-of-hospital cardiac arrest according to bystander gender. Methods: We used a nationwide, out-of-hospital cardiac arrest cohort database during 2006-2020. We extracted cases involving patient older than 18 years with presumed cardiac etiology and witnessed arrest, but not by EMS or nursing home worker or medical personnel. The primary outcome was the good neurologic outcome. Secondary outcomes were successful bystander cardiopulmonary resuscitation rate which defined that starting bystander CPR and keep going until by EMS arrival and survival outcome. Results: The total number of populations was 24919 patients. Of these, 10413 patients (41.8%) were resuscitated by female bystander. When cardiopulmonary resuscitation by female bystander, patient more likely to achieve good neurological outcome (206(2.0%) vs 235(1.6%), p=0.344), and survival (352(3.4%) vs 400(2.8%), p=0.0046). However, female bystander less likely to do successful cardiopulmonary resuscitation (5730(55.0%) vs 9405(64.8%), p&lt;0.0001). Adjusted odds ratios for good neurologic outcomes, survival and successful bystander cardiopulmonary resuscitation rate resuscitated by female bystander, when compared with male bystander, were 1.46 (1.18-1.80), 1.44 (1.23-1.69) and 0.68 (0.64-0.71), respectively. In the interaction model, adjusted odd ratio (95% Confidence interval) for good neurological outcome of patient resuscitated by female bystander was 1.53 (1.21-1.94) in patients who arrested at private place and 1.18 (0.71-1.98) in patients who arrested in public place. Conclusion: Patient who resuscitated by female bystander were more likely to have good neurologic outcome and achieve survival discharge. Effect of bystander gender was increased when patient arrested in private place.
Abstract 14111: Rhythm and Race: A Qualitative Assessment of Black Patients’ Experiences Living With Atrial Fibrillation
Authors: Harnoor Mann, Flor de Abril Cameron, Julia Wasilewski, Megan E Hamm, Danielle Ferry, Jared W Magnani, Amber E Johnson
Journal: Circulation (2022)

Introduction: Race-based disparities in atrial fibrillation/flutter (AF) outcomes have been well-documented, but few studies have investigated individuals’ experiences of living with AF, particularly among Black individuals. Hypothesis: We aimed to identify themes regarding challenges Black patients experience in self-managing their AF. Methods: Three focus groups of four to six participants (sixteen in total) were recruited from the racial/ethnic minority participants in the Atrial Fibrillation Heath Literacy and Information Technology Trial (AFib-LITT). A tailored qualitative script was developed to assess the perspectives of participants in semi-structured focus groups. Audio recordings of focus group interviews were inductively coded using a descriptive approach to identify recurrent themes. Results: Participants were mostly male (62.5%) with mean age of 66.5 (range 40-78) years. Three themes emerged regarding 1) the physical and mental burdens of disease, 2) the need for interpersonal support systems, and 3) the importance of community understanding of AF. Focus group participants stated that the paroxysmal nature of the disease also created the sense that the disease was uncontrollable. The erratic nature of AF caused them to limit their physical exertion to prevent AF symptoms, thus skipping activities that were integral to their lives. Conclusions: Black patients found that the unpredictability of their AF symptoms led them to describe the disease as difficult to manage, but social and community support may serve as areas for future interventions. These social and behavioral themes highlight the need for tailored clinical strategies for AF self-management within a patient’s social context.
Abstract 13405: Early Age at Menarche and Risk of Stroke - A Systematic Review and Meta-Analysis of Prospective Studies
Authors: Brian BRERETON, Prerna Bansal, Harika Varma Chintalapalli Patta, Geethu Jnaneswaran, Jaswanth Rao Jasti, Bhavyasri Merugu, Athul Raj Raju, Blessy George, Frailyn Nunez, Gowri Anil Peethambar, Rupak Desai
Journal: Circulation (2022)

Background: Despite previous studies exploring female reproductive factors, early menarche and its impact on stroke risk remains under-reported. This systematic review seeks to further explore this correlation. Methods: PubMed, SCOPUS and EMBASE databases were systematically reviewed for studies reporting long-term incidence and odds of stroke in patients who had menarche at an early age vs. menarche at a normal age. Random effects models were used for the meta-analysis and subgroup analysis. I2 statistics were used to identify substantial (&gt;75%) heterogeneity. A sensitivity analysis was performed using the leave-one-out method. Results: Ten prospective studies with a total of 1,971,454 patients were included and the odds of stroke were evaluated for patients with early menarche vs controls. Overall unadjusted odds for stroke with early menarche was 1.14 (95%CI 1.08 -1.20, p&lt;0.01, I2=0%). (Fig.1b) Adjusted odds ratio; [aOR 1.22 (95% CI 1.08 - 1.39), I2=86.85%, p&lt;0.01]. (Fig. 1a) Leave-one-out sensitivity analysis confirmed equivalent results. (Fig.1c) On subgroup analysis, studies from the USA with early menarche had the highest stroke risk of countries reported (1.48, 95%CI 1.04-2.09) followed by China (1.26, 95% CI 1.09-1.45) and the UK (1.08, 95%CI 0.96-1.21). There was stronger stroke association with mean/median age cohort ≥ 60 yrs (1.43, 95% CI 1.08 - 1.89) vs &lt;60 yrs (1.18, 95% CI 1.03 - 1.36). Conclusions: This meta-analysis revealed that early menarche is associated with a higher risk of stroke with the strongest association in women from the USA.
Abstract 13096: Outcomes After Coronary Artery Bypass Grafting With Bilateral Internal Mammary Arteries in Obese Patients
Authors: Chikashi Nakai, Cheng Zhang, Jeffrey Cohen, Christian Shults, Ron Waksman, Ezequiel J Molina
Journal: Circulation (2022)

Introduction: The purpose of this study was to evaluate the postoperative outcomes with the use of bilateral internal mammary artery (BIMA) conduits in obese patients. Methods: Between January 2003 and December 2018, 8109 patients underwent isolated coronary artery bypass grafting (CABG) at our institution, including 7218 (89.0%) treated with single internal mammary artery (SIMA) and 891 (11.0%) treated with BIMA. Patients were divided into three groups according to preoperative body mass index (BMI), normal or BMI&lt;25 (22.2%), overweight or 25-BMI&lt;30 (37.2%), and obese or BMI&gt;30 (40.6%). In each group, BIMA and SIMA patients were compared to investigate the thirty-day mortality and postoperative complications. Significant baseline differences were observed between the three BMI groups and such differences were adjusted via inverse probability weighting matching. Results: The thirty-day mortality, deep sternal wound infection (DSWI) rates and length of hospital stay were 1.4%, 0.5%, and 6.0 ± 9.1 days for the normal group, 0.2%, 1.0% and 5.5 ± 4.2 days for overweight group and 0.9%, 1.8% and 5.5 ± 4.0 days for the obese group. There was no significant difference in the thirty-day mortality, incidence of DSWI and hospital stay between BIMA and SIMA groups, except in the obese group where the rate of DSWI was significantly higher in the BIMA patients (3.4 vs 0.0%, p=0.02). Conclusions: BIMA for isolated CABG in obese patients can be used without an increase of the thirty-day mortality and hospital stay. However, the use of BIMA in obese patients may lead to an increase of postoperative DSWI.
Abstract 13277: Hiv and Race Are Independently Associated With Endothelial Dysfunction
Authors: Christian Mouchati, Jared Durieux, Sokratis N Zisis, Grace A McComsey
Journal: Circulation (2022)

Objective: Assessing the vascular function in HIV + compared to HIV - with assessment of body composition, inflammation, and gut integrity markers. Introduction: HIV and ART are associated with an increased risk of CVD. Thus, the need for a non-invasive test to detect increased risk or early signs of CVD. Hypothesis: HIV and non-white race are independently associated with vascular dysfunction. High viral load, BMI, and inflammation damage endothelial function. Methods: We included participants ≥18 years, with peripheral arterial tonometry testing (EndoPAT2000) between 2014-2022. HIV + had a stable ART regimen, and a VL ≤400 c/mL. We measured the vessel’s adaptability with Reactive Hyperemia Index (RHI) (normal&gt;1.67) and elasticity with Augmentation Index (AI) (normal&lt;-10). We assessed markers of systemic inflammation, immune activation, and gut integrity. We used linear mixed models to estimate endothelial dysfunction with a significant p-value&lt;0.05. Results: Overall, 511 participants (296 HIV+ and 215 HIV-) were included. The estimated RHI among HIV+ was 13% lower (p=0.01) compared to HIV-. In Non-White, the estimated RHI was 9% lower (p=0.001) than in White. Every 1% increase in BMI we would expect RHI to increase 0.17% (p=0.01). At the time of EndoPAT, the estimated RHI was 8% lower (p=0.04) among PI antiretroviral therapy use compared to HIV+ who were taking NRTI or NNRTIs. The estimated odds of having endothelial dysfunction (RHI ≤ 1.67) is 1.56 times greater (95% CI: 1.05, 2.31) in Non-White compared to White, independent of HIV status [OR=1.4 (95% CI: 0.94, 2.13)]. There was not enough evidence to suggest that inflammation, gut, or monocyte markers, current or nadir CD4, duration of HIV, or current treatment with NRTI or NNRTIs at the time of EndoPat was associated with endothelial dysfunction. Conclusions: HIV and non-white race are independently associated with endothelial dysfunction. PI use was associated with vascular dysfunction in all racial groups.
Abstract 13958: Evolocumab Alters Vascular Function in Patients With Cardiovascular Disease
Authors: Dennis Kannenkeril, Agnes Bosch, kristina Striepe, Laura Berner, Robert Pietschner, Julie Kolwelter, Christian Ott, Mario Schiffer, Stephan Achenbach, Roland E Schmieder
Journal: Circulation (2022)

Background: The aim of this study was to analyze the effect of evolocumab on vascular function and structure in patients with cardiovascular disease. Methods: This was a prospective, double-blinded, randomized, controlled study (NCT03626831) including patients with cardiovascular disease and treated with statins. Patients were consecutively randomized (1:1) to either evolocumab treatment (420mg was administrated twice during the study) or placebo. All patients underwent vascular examination at baseline, and after 1, 4 and 8 weeks of treatment by the SphygmoCor XCEL System (pulse wave analysis) and the UNEX EF 18G system (endothelial function). Endothelial function parameter such as flow-mediated vasodilation (FMD), low flow-mediated vasoconstriction (L-FMC) and vasoactive range (VAR) were measured. Moreover, pulse wave analysis parameters such as central systolic pressure, central pulse pressure, augmentation index, pulse wave velocity were measured. Results: 103 patients with a mean age of 66.2 (±7.7) years and a mean LDL-cholesterol of 98.2 (±19.1) mg/dl completed the study. LDL-cholesterol decreased significantly already after 1 week of treatment with evolocumab compared to baseline (-47.4 (±13.1) mg/dl). Endothelial function parameter (VAR) increased after 8 weeks of treatment with evolocumab compared to baseline (p=0.034), whereas there was no significant change at 1 and 4 weeks after treatment. Moreover, an improvement in VAR from baseline at week 8 was found with evolocumab compared to placebo (p=0.045). No change in the pulse wave analysis parameters were found with treatment. In a subgroup analysis, in patients with age ≤67 years, lower systolic blood pressure (≤125 mmHg) or higher baseline LDL-cholesterol (&gt;95 mg/dl), significant evolocumab treatment effect was found in VAR improvement (p=0.006, p=0.049 and p=0.042, respectively) from baseline at week 8. Conclusion: Our data indicate that endothelial function could be improved with evolocumab treatment in high-risk patients with preexisting cardiovascular disease and on statin therapy. Our results contribute to the mechanistic explanation why lower incidence of the cardiovascular composite endpoint has been demonstrated in the FOURIER study.
Abstract 14231: Egg Consumption Induces Sex-Specific Changes in High-Density Lipoprotein Composition and Function
Authors: Lindsey Huang, Chelsea Garcia, Olivia Corvino, Hayoung Woo, Hyungryun Jang, Ruijie Zhang, Rachael Woodruff, Christopher Blesso, Ji-Young Lee, Christa Palancia Esposito, Catherine J Andersen
Journal: Circulation (2022)

Introduction: HDL composition is an important determinant of cardioprotective functions. Importantly, sex-specific differences in HDL composition and function have been observed. While diet represents a promising therapeutic strategy to optimize HDL composition and function, it is unclear whether the capacity to modulate HDL profiles through diet is sex-specific. Hypothesis: We hypothesized that daily consumption of different egg-based diets, which differentially impact HDL particle profiles and efflux capacity, would alter HDL composition and function in a sex-dependent manner. Methods: Healthy men and women (n = 26) participated in a 16-week randomized, crossover intervention trial (NCT03577223), in which they consumed a 4-week egg-free diet, followed by a 4-week diet containing either 3 whole eggs or 3 egg whites per day. Participants then followed a 4-week egg-free washout diet, before switching to the alternative whole egg or egg white diet treatment. Fasted blood samples were collected after each diet period to determine HDL particle profiles by NMR, serum paraoxonase 1 (PON1) lactonase activity, cholesterol efflux capacity, and HDL lipid and protein composition. Results: We observed sex-specific differences in HDL profiles following egg intake. In women, whole egg intake increased HDL-phosphatidylcholine and phosphatidylethanolamine content, whereas HDL-phosphatidylinositol and sphingomyelin were increased and decreased, respectively, in men. Similarly, egg diets differentially and sex-dependently altered HDL proteins implicated in cholesterol efflux capacity and cardiovascular disease risk. Whole egg intake increased HDL-apoAII, apoL1, apoM, and lowered serum amyloid P compared to the egg-free and egg white diets in women, whereas HDL-PON3 was increased by egg white intake in men. PON1 activity and cholesterol efflux capacity were increased following whole egg intake in women only. Independent of sex, changes in cholesterol efflux capacity between the egg white and whole egg periods were positively correlated with the number of total and small HDL particles. Conclusions: Modulation of HDL profiles by diet are sex-specific, with whole egg intake promoting more significant changes in HDL composition and function in women.